NURS 8700 – DNP Project Mentoring Essay 

According to the Nursing and Midwifery Council (NMC) (2006) the term mentor is used to denote the role of a registered nurse who facilitates learning and supervises and assesses students in the practice place. They furthermore identify the eight mandatory standards that must be achieved to become a mentor, and within the assignment I shall be referring to the Standards to Support Learning and Assessment in Practice; NMC standards for mentors, practice teachers and teachers, and identifying the standards for mentors required (SM). NURS 8700 – DNP Project Mentoring Essay Paper

This assignment will first look at the personal and professional reasons why I wanted to undertake the mentorship module. It will also discuss the importance of a supportive learning environment in the workplace, and how essential it is. My role as a mentor to a nursing student will be evaluated, looking at the way in which I supported her on the ward and how I facilitated this. In conclusion, I will identify my own personal development in undertaking and completing this module.

As a registered nurse on a busy Paediatric ward I always enjoy supporting student nurses whilst they are on placement with us. There is an apparent shortage of qualified mentors on the ward, and within my last personal development review with my line manager I identified a need to attain the mentorship qualification. The Nursing and Midwifery Council (NMC) (2004) states, that as a registered nurse, you must keep your knowledge and skills up-to-date throughout your working life. You also have a duty to facilitate nursing students and others to develop their competence. According to Hand (2006), teaching is seen as an important part of the health professional’s role, and at some point in their career, members of most healthcare professions are expected to teach other staff, students, patients and relatives. Therefore, the standard of teachers and mentors available in the practice place will have a major impact on the quality of future practitioners, consequently making an improvement in patient care. Most students and many professionals note that learning acquired from placement experience is much more meaningful and relevant than that acquired in the lecture room (Quinn 2000). NURS 8700 – DNP Project Mentoring Essay Paper

To ensure any learner has a positive learning experience it is essential that the learning environment is practically, professionally, and psychologically supportive to all who work and learn within it. Clarke et al. (2003) notes that current nurse education puts a high value on learning in the clinical environment and this places numerous demands on clinical areas and staff. The quality of these clinical placements has a significant influence on the learning process for nursing students. The ward on which I work aims to foster a good all-round learning experience to students on placement as we are fortunate to be a well resourced ward with many experienced staff. Although we are an extremely busy ward, students are positively received and supported well, the majority wishing to work with us once qualified.

On commencement of the mentorship module it was found that there were no students or learners available to me initially so the time span for my period of mentoring for the purpose of the assignment was limited to just one month. I was however, able to identify my own clinical mentor on the ward, and after analysis of my own strengths, weaknesses, opportunities and threats (SWOT) I decided on my short and long term goals and set a learning contract with my mentor in readiness for the allocation of a student. Jasper (2003) regards SWOT analysis as getting to know yourself. The understanding of our skills and abilities and the awareness of where our limits lie is seen as crucial to being able to act as a professional practitioner. NURS 8700 – DNP Project Mentoring Essay Paper

I was finally allocated a first year child branch student, and was informed by the matron that this would be her first clinical placement. It was important to know where she was in her training for me to plan adequately when supporting her on the ward. A frequently used taxonomy in nurse education is the framework by Benner (2001) in which there are five levels; novice, beginner, competent, proficient, and expert. Benner (2001) suggests that nurses may be at different levels in different areas dependent on their previous experiences. NURS 8700 – DNP Project Mentoring Essay Paper

It was unfortunate that I was not able to work with her on her first shift as I was finishing the nightshift as she was starting with the dayshift. I did however welcome her to the ward and orientated her to it, ensuring she knew who she would be working with on her first ever clinical shift. Davidson (2005) notes that students can be made to feel welcome by someone simply knowing their name and being expected. He also notes that a physical tour is a good start. This allows for brief introductions to other staff that the student will be working with. On this initial meeting I also gave her the ward’s student nurse orientation/resource pack. This provided her with basic information about the ward and the different teams and staff within it, this was to provide a good introduction into the environment that she would be learning in during her placement. NURS 8700 – DNP Project Mentoring Essay Paper

Two days after she began, we had our first clinical shift together. I was pleased to hear that she had found other members of staff supportive during her first two days on the ward. Cahill (1996) acknowledges that the single most crucial factor in creating a positive learning environment is the relationship between staff and nursing students. She also notes that a common problem for students is that they are unable to work regularly with their mentor, so I took this opportunity to discuss and plan her off-duty taking into account any requests she had. Kenworthy and Nicklin (2000) remark that the more comfortable and safe a student feels within the environment, the more likely it is that effective learning will take place and the student will become motivated to learn. I was also able to discuss the learning pack which I had previously given her and she acknowledged that it appeared to be very informative. Morton-Cooper and Palmer (2000) state that although, in practice the mentor acts as a learning resource, it is necessary for the student to become self directed in the development of their learning needs.

An important part of her placement was to establish a learning contract with myself as her clinical mentor. A learning contract is a document used to assist in the planning of a learning project. It is a written agreement negotiated between the learner and the mentor in which learning needs are identified (Lowry 1997). In order to do this successfully we needed to identify her learning objectives which included the learning outcomes of the modules to be assessed in practice. As this was her first attempt to set a learning contract it was important for me to support her through the process. Twentyman et al (2006) discuss assisted learning where the mentor asks the student to identify their goals and aim to secure learning opportunities that support the achievement. Jackson and Mannix (2001) note that amount of interest the nurse shows in the learning needs of the student and the key role he or she plays in their achievement are essential to the student’s development. NURS 8700 – DNP Project Mentoring Essay Paper

During the shifts that I worked with her we discussed her required learning outcomes and during one of our formal meetings we agreed her learning contract. Within this learning contract she had identified that she needed to develop her awareness in the safe use of medical equipment used on the ward and the principles regarding using these. Quinn (2000a) remarks that it is important to have knowledge of the student’s programme and the required outcomes in order to ensure effective learning.

After discussion with her it was decided that a teaching session surrounding the safe use of blood glucose monitoring equipment would be of benefit to her, as it was a procedure that was often required on the ward. It would cover one of her learning outcomes, and I agreed to facilitate this. Wallace (2003) notes, that it is important to reduce the possibility of exposing student or patient to any risk, until the student has acquired sufficient skill and knowledge when carrying out a practical procedure. The importance of assessment by a mentor is therefore crucial to ensure students become proficient in practical skills. The commonly held principle that accountability comes from training and education, is evident within the student nurse role. According to Pennels (1997) if accountability comes with knowledge, students are rightfully protected from full accountability until trained. Although responsible for their actions their knowledge base may be inadequate to allow accountability. Therefore, professional accountability lies with the registered nurse that a student nurse works with. It was reassuring for me that she and I had quickly developed an effective working relationship in which I had confidence in her ability to always ask if she became unsure about a situation. She appeared to fully understand her role as a student nurse as identified in the NMC guide for students of nursing and midwifery (NMC 2006a). NURS 8700 – DNP Project Mentoring Essay Paper

Before embarking on any programme of teaching it is important to recognise that there are different learning theories and styles to consider. Reece and Walker (2003) state that there is a great deal written about the way people learn and numerous theories on the methods to teach effectively or guide people in learning. They discuss that the main learning theories are Behaviourism, Cognitivism and Humanism.

According to the Behaviourism theory (Skinner 1974), the learning environment is fundamental to learning, and if this environment is right, learning occurs as connections are made between stimulus and response, and response and reinforcement (cited by Quinn, 2000a). The Cognitive theory (Bruner 1966) considers learning as an internal process that involves higher order mental activities such as memory, thinking, problem-solving, perception and reasoning (cited by Hand, 2006). The Humanistic learning theory (Maslow 1968) is based on the belief that humans have two basic needs, a need for growth and a need for positive regard by others. It is seen as the most holistic approach as it takes into account the drive and motivation of an individual to learn. Reece and Walker (2003) suggest that this theory also depends on the overall influence of the environment which may hinder or aid the learning process. NURS 8700 – DNP Project Mentoring Essay Paper

Honey and Mumford (1992) discuss four different learning styles, and whenever possible, it is important to allow the student’s own style to influence your choice of teaching method. They describe learners as activists, pragmatists, theorists or reflectors. They further note that although many people were a mixture they generally had a preference for one style.

To ensure her learning experience on the ward was successful it was important for me as her mentor to be aware of her preferred learning style as clinical education is an essential part of the nursing curriculum. During the shifts that I had worked with her, and with discussion it was established that she preferred a more practical experience therefore she favoured a pragmatist approach to learning. I therefore incorporated her preferred learning style into my planned teaching session.

To enable an effective teaching session to take place, I as the facilitator needed to select an appropriate environment which was safe, clean, private and comfortable. It was also important that my learner, clinical mentor and myself were guaranteed time free from interruptions. The SWOT analysis that I had completed had highlighted the difficulties on the ward often found when teaching sessions were cancelled due to staff being too busy to attend. I therefore negotiated in advance protected time for all parties for this facilitation of learning and assessment. Davison (2005) notes that mentors need to plan ahead as good preparation can ease the experience for all parties. Watson (1999) also states that if teaching opportunities for students are to be meaningful and productive, planning is an important part of the mentor’s role. Although I felt I had established a good relationship with her since she had been working with me, it was important for me as her mentor to be aware of learner anxiety as discussed by Price (2005). Anxiety is seen as disabling and requires mentor support if progress is to be made when learning in practice. Good communication skills are paramount when mentoring students, and diplomacy and tact must be employed when students need extra help in challenging situations. It is also worth noting that as a mentor with good communication and practical skills facilitating a well planned teaching session, I still experienced some anxiety. Price (2005) notes this often happens when your practice is being held up as exemplary and your knowledge may be tested later. NURS 8700 – DNP Project Mentoring Essay Paper

On reflection I felt the teaching session achieved all the objectives set, and she was able to demonstrate this to me in both verbal feedback and the self assessment sheet provided. I also received positive verbal and written feedback from my clinical mentor. McAllister et al (1997) suggest the intention of giving positive feedback is to aid the receiver when developing their clinical and interpersonal skills. Reflective practice in nursing has been encouraged since the 1980’s (Jasper 2003). Johns (1995) describes the process of reflection as a tool we use to assess, understand and learn through our lived experiences. Jasper (2003) also acknowledges that reflective practice is seen as one of the ways we can learn from our experiences, and in education for healthcare professions it is recognised as an essential tool for assisting students to make the links between theory and practice. As an effective mentor it is important for me to understand the value of supporting her in critically reflecting upon her learning experiences in order that her future learning can be enhanced, and when working with her I have actively encouraged her to do so.

In conclusion, through undertaking and completing this module, I have developed an advanced knowledge and critical awareness of mentorship in health care practice. I have been encouraged to look at my own practice, ensuring that it is evidence based at all times, thus enabling me to fully support students in applying evidence base to their own practice. Research into the learning environment has clearly shown the impact that it can have on student learning and I intend to ensure that the ward resources are kept up to date for all learners. The exploration of learning theories and styles within the module has allowed me to acquire valuable understanding of the philosophies and theories surrounding learning, teaching and assessing and when planning learning experiences for students I now feel more equipped to integrate theory into practice. It is also important that once becoming a qualified mentor I attend the regular updates provided by the university, as the role of a mentor will be seen as the gate keeper to the profession. This will in turn enable me to mentor students more effectively on the ward as the importance of the mentor’s role in assessing practice cannot be over-emphasised. NURS 8700 – DNP Project Mentoring Essay Paper

tial I: Scientific Underpinnings for PracticeThe DNP program prepares the graduate to:1. Integrate nursing science with knowledge from ethics, the biophysical, psychosocial, analytical,and organizational sciences as the basis for the highest level of nursing practice.2. Use science‐based theories and concepts to:-Determine the nature andsignificance of health and healthcare delivery phenomena;-Describe the actions and advanced strategies to enhance, alleviate, and ameliorate healthand health care delivery phenomena as appropriate; and-Evaluate outcomesEssential II: Organizationaland systems Leadership for Quality Improvement and systems thinkingThe DNP program prepares the graduate to:1. Develop and evaluate care delivery approaches that meet current and future needs of patientpopulations based on scientific findings in nursing and other practicumsciences, as well asorganizational, political and economic sciences.2. Ensure accountability for quality of health care and patient safety for populations with whomthey work.-Use advanced communication skills/processes to lead quality improvement and patientsafety initiatives in health care systems.-Employ principles of business, finance, economics, and health policy to develop andimplement effective plans for practice –level and/or system‐wide practice initiatives thatwill improve the quality of care delivery.-Develop and/or monitor budgets for practice initiatives.-Analyze the cost‐effectiveness of practice initiatives accounting for risk andimprovement ofhealth care outcomes.-Demonstrate sensitivity to diverse organizational cultures and populations, includingpatients and providers.-Develop and/or evaluate effective strategies for managing the ethical dilemmas inherent inpatient care, the health care organization, and research.Essential III: PracticumScholarship and Analytical Methods for Evidence‐Based PracticeThe DNP program prepares the graduate to:1. Use analytic methods to critically appraise existing literature and other evidence to determineand implement the best evidence for practice.2. Design and implement processes to evaluate outcomes of practice, practice patterns, andsystems of care with a practice setting, health care organization, or community against nationalbenchmarks to determine variances in practice outcomes and populations trends.3. Design, direct, and evaluate quality improvement methodologies to promote safe, timely,effective, efficient, equitable, and patient‐centered care.4. Apply relevant findings to develop practice guidelines and improve practice and the practiceenvironment.5. Use information technology and research methods appropriately to:-Collect appropriate and accurate data to generate evidence for nursing practiceDNP MentorHandbook-Inform and guide the design of data bases that generate meaningful evidence for nursingpractice. NURS 8700 – DNP Project Mentoring Essay Paper

10-Analyze data from practice-Design evidence‐based interventions-Predict and analyze outcomes-Examine patterns of behavior and outcomes-Identify gapsin evidence for practice6. Function as a practice specialist/consultant in collaborative knowledge‐generating research.7. Disseminate findings from evidence‐based practice and research to improve healthcareoutcomes.Essential IV: Information systems/Technology and Patient Care Technology for the Improvement andTransformation of Health CareThe DNP program prepares the graduate to:1. Design, select, use, and evaluate programs that evaluate and monitor outcomes of care, caresystems, and quality improvement including consumer use of health care information systems.2. Analyze and communicate critical elements necessary to the selection, use and evaluation ofhealth care information systems and patient care technology.3. Demonstrate the conceptualability and technical skills to develop and execute an evaluationplan involving data extraction from practice information systems and databases.4. Provide leadership in the evaluation and resolution of ethical and legal issues within healthcaresystems relating to the use of information, information, technology, communication networks,and patient care technology.5. Evaluate consumer health information sources for accuracy, timeliness, and appropriateness.Essential V: Health Care Policy for Advocacy in Health CareThe DNP program prepares the graduate to:1. Critically analyze health policy proposals, health policies, and related issues from the perspectiveof consumers, nursing, other health professions, and other stakeholders, in policy and publicforums.2. Demonstrate leadership in the development and implementation of institutional, local, state,federal, and/or international health policy.3. Influence policy makers through active participation on committees, boards, or task forces atthe institutional, local, state, regional, national, and/or international levels to improve healthcare delivery and outcomes.4. Educate others, including policy makers at all levels, regarding nursing, health policy, and patientcare outcomes.5. Advocate for the nursing profession within the policy and healthcare communities.6. Develop, evaluate, and provide leadership for health care policy that shapes health carefinancing, regulation, and delivery.7. Advocate for social justice, equity, and ethical policies within all health care arenas.Essential VI: Interprofessional Collaboration for Improving Patient and Population Health OutcomesThe DNP program prepares the graduate to:1. Employ effective communication and collaborative skills in the development andimplementation of practice models, peer review, practice guidelines, health policy, standards ofcare, and/or other scholarly products.2. Lead interprofessional teams in the analysis of complex practice and organization issues.3. Employ consultative and leadership skills with intraprofessional and interprofessional teams tocreate change in health care and complex health care delivery systems. NURS 8700 – DNP Project Mentoring Essay Paper

11Essential VII: PracticumPrevention and Population Health for Improving the Nation’s HealthThe DNP program prepares the graduate to:1. Analyze epidemiological, biostatistical, environmental, and other appropriate scientific datarelated to individual, aggregate, and population health.2. Synthesize concepts, including psychosocial dimensions and cultural diversity, related to practicumprevention and population health in developing, implementing, and evaluating interventions toaddress health promotion/disease prevention efforts, improve health status/access patterns,and/or address gaps in care of individuals, aggregates, or populations.3. Evaluate care delivery models, and/or strategies using concepts related to community,environmental and occupational health, and cultural and socioeconomic dimensions of health.Essential VIII: Advanced Nursing PracticeThe DNP program prepares the graduate to:1. Conduct a comprehensive and systematic assessment of health and illness parameters incomplex situations, incorporating diverse and culturally sensitive approaches.2. Design, implement, and evaluate therapeutic interventions based on nursing science and othersciences.3. Develop and sustain therapeutic relationships and partnerships with patients (individual, familyor group) and other professionals to facilitate optimal care and patient outcomes.4. Demonstrate advanced levels of practicumjudgment, systems thinking, and accountability indesigning, delivering, and evaluating evidence‐based care to improve patient outcomes.5. Guide, mentor, and support other nurses to achieve excellence in nursing practice.6. Educate and guide individuals and groups through complex health and situational transitions.7. Use conceptual and analytical skills in evaluating the links among practice, organizational,population, fiscal, and policy issues. NURS 8700 – DNP Project Mentoring Essay Paper

The 36 credit post master’s DNP program at UDM builds on master’s level education to provide an expanded level of unique knowledge and expertise in advanced practice nursing roles. The DNP curriculum is designed to provide students the opportunity to assimilate and utilize in-depth knowledge of nursing, biophysical, psychosocial, analytical and organizational sciences, with sophisticated informatics and decision-making technology to develop collaborative strategies that optimize the health of individuals, families, communities and systems. Grounded in the Mercy and Jesuit traditions, the DNP program emphasizes the student’s development as an expert clinician with strong leadership capacity, a commitment to service and skills to act as change agents, translating clinical research into improved health care. The interdisciplinary curriculum features expert faculty from different disciplines and fosters a high quality teaching-learning environment.Thecurriculum includes formative coursework that culminates in a practicum experience and doctoral project. Graduates of the Doctor of Nursing Practice degree program achieve the following terminal objectives:1. Engage own professional role practice consistent with the competencies of the Doctor of Nursing Practice. 2. Formulate innovative theoretical and conceptual frameworks that ensure optimal health care quality and patient safety outcomes. 3. Translate evidence to produce innovative models of care that integrate informatics, health care technology, and interpersonal collaboration to affect population health, outcomes, and support health care policy initiatives. 4. Lead health care systems and policy innovation with a focus on preventative care, quality improvement and patient advocacy. 5. Integrate the Mercy and Jesuit traditions in providing culturally competent, compassionate, holistic and person-centered care with a commitment to human dignity in the contemporary world. NURS 8700 – DNP Project Mentoring Essay Paper

Nurses are expected to provide the best standards of care possible for their patients and clients, and in order to do this, they are required to provide evidence-based practice wherever possible. Part of this process of providing care based on the best available evidence involves appraising primary research (Elliott, 2001, p 555). If nurses are to improve their practice, and apply evidence to improve their clinical and theoretical knowledge and skills, they must be able to assess the quality of the available research which is relevant to their practice (Freshwater and Bishop, 2003k p23; Hek, 2000, p 19). According to Hek (2000 p 19-21), evidence based practice incorporates professional expertise, patient need and preference, and the best available evidence. But in order to identify this ‘best evidence’, the nurse must undertake an evaluation and critical review of research studies, to see if the research is useful and of sufficient quality to be applied to their practice (Fink, 2005).

This essay evaluates a quantitative research article which has relevance to nursing practice, because it deals with a chronic condition and one which is prevalent in worldwide populations. The author will review Tangkawanich et al (2008 p 216) ‘Causal model of health: health-related quality of life in people living with HIV/AIDS in the northern region of Thailand.’ This article is published in a reputable journal, The Journal of Nursing and Health Sciences which addresses issues of interest and concern to nurses internationally, and as such, offers specific insight into HIV/AIDS and nursing within a global context. NURS 8700 – DNP Project Mentoring Essay Paper

There are a number of appraisal tools available to healthcare practitioners to assist them in analysing and critiquing primary research articles. Such models are developed over time in relation to standardised conceptualisations of what constitutes quality and rigour in research and in its reporting. For the purposes of this essay, the primary tool used is that proposed by Cormack (2000), but the author will make reference to other critiquing guides and information, including the popular CASP tool (PHRU, 2009, online)

Discussion

1. Title

The title is concise (Cormack, 2000) and describes the focus of the research itself. While it clearly indicates what the purpose of the study was (Cormack, 2000), it could be clearer and more indicative of the nature of the study. While the nature of the research in setting out to ‘examine the causal relationships between age, antriretroviral treatment, social support, symptom experience, self-care strategies and health related quality of life’ (Tangkawanich et al, 2008 p 216) in the chosen sample and population, is apparent in the abstract, there is little indication of these particular variables in the title, although the description of the ‘causal model’ (Tangkawanich et al, 2008 p 216) does indicate the nature of the research. The use of the word ‘causal’ (Tangkawanich et al, 2008 p 216) also suggests that this is a quantitative research article. It does not clearly indicate the research approach used (Cormack, 2000). To the less research-aware reader, it would be difficult to divine this information from the title alone, and it could be argued that it would be better to include in this title a clearer indication of the nature of the study. This would then help the reader to identify if this is the type of research study that would be applicable to their own practice or learning. NURS 8700 – DNP Project Mentoring Essay Paper

2. Authors

The authors’ qualifications are provided, and they all are registered nurses, all of which have postgraduate degrees, and two of which have doctorates. They all work within nursing education within a University context. This would suggest that they have the research skills and expertise to carry out such a study. However, there is no indication in the author list whether or not any of them have the statistical expertise for the study.

3. Abstract

Tangkawanich et al, (2008 p 216) provide an abstract, which is identified by Cormack (2000) as an important introduction to the article. The study effectively summarises the research, by identifying the variables being tested. The authors do not, however, present the hypothesis in the abstract (Cormack, 2000). The abstract contains a summary of the study sample, and also identifies the research tools that have been used. They include the results and a summary of conclusions from these findings. As such, the abstract does represent the article itself (PHRU, 2009, online), and for the reader, it does make it easy to identify whether or not the article is relevant to their interest. In particular, it does indicate clearly that it is a quantitative paper which uses recognisable data collection tools. NURS 8700 – DNP Project Mentoring Essay Paper

4. Introduction and Literature Review

Although Cormack (2000) separates these two into distinct subheadings, within this article, the introduction and literature review are contiguous. The author has noted that this is often the case in the reporting of such studies, but this may simply be a convention of the publication itself, and not the preference of the authors of the study. The authors use the introduction to contextualise the problem in relation to published research, stating the importance of health-related quality of life (HRQL) for people living with HIV/AIDS (PLWHA), because of the impact of the disease on these individuals’ daily lives (Tangkawanich et al, 2008 p 216). They discuss changes and advances in treatment options for this condition, and relate this to HRQL, and then discuss the disease itself, and how these impact upon HRQL (Tangkawanich et al, 2008 p 216). They summarise some research about this topic, and also look at self-care strategies, symptom management and treatment (Tangkawanich et al, 2008 p 216). There is some exploration of HRQL and its relationship to nursing and to existing literature on this topic, which aids understanding of the concept prior to reading the rest of the article. They highlight some important topics in relation to the focus of the article, including treatment, social support, and other issues (Tangkawanich et al, 2008 p 216).

Although the introduction/literature review contextualises and introduces this study, this author believes that a more detailed critical analysis of the literature would be warranted here. It is not enough to cite previous research as a means of establishing the credentials of the study, as it were. A wider range of research could have been included Gerrish and Lacey, 2006, 38; Fontana, 2004, p 93), and this research could have been evaluated to identify its quality. It is left to the reader to pursue this matter and determine the quality of the research upon which they base the premise and justification for this study. This could be considered a limitation in the reporting of this research. NURS 8700 – DNP Project Mentoring Essay Paper

5. The Hypothesis

The authors do not state a hypothesis (Cormack, 2000), as such, but instead present a research question. ‘The purpose of this study was to examine the causal relationships between age, antiretroviral treatment, social support, symptom experience, self-care strategies, and the HRQL in Thai PLWHA’ (Tangkawanich et al, 2008 p 217). The nature of this statement would suggest that it is not an experimental study, but that it is within a quantitative research paradigm.

6. Operational definitions

Cormack (2000) suggests that people appraising research question whether operational definitions are clearly presented. In this study, operational definitions are explained within the introduction but in language that would make it inaccessible to the less experienced or less knowledgeable reader. NURS 8700 – DNP Project Mentoring Essay Paper

7. Methodology

The methodology section does not clearly state or discuss the choice of a quantitative approach (Cormack, 2000). The focus of the section on Methods is rather on the instruments that are being used. The quality of this study seems to rest in the choice of a quantitative approach, and the choice of data collection instruments. Quantitative research approaches offer a better standards of evidence, with generally greater ability for replication and greater rigour (Kitson et al, 2000 p 149; Duffy, 2005, p 233). As far as research for healthcare practice is concerned, quantitative studies hold better status than those based with a qualitative paradigm (Hek, 2000 p 19; Newman et al, 1998 p 231; Pepler et al, 2006, p 23). There is however no real discussion of the underpinning principles of quantitative research (Parahoo, 2006).

It is good that the research instruments are explained in such detail, because it helps overcome one of the limitations of quantitative research, that of not asking the right questions to elicit answers that relate to person al experience (Johnson and Onwuegbuzie, 2004 p 14).

8. Subjects

There is very limited detail given of sample selection, save stating that eight hospitals were randomly selected using a ‘lottery method without replacement’ and that the 422 participants were randomly sampled (Tangkawanich et al, 2008 p 217). This could constitute a limitation of this research, as it is not possible to identify if there was any sampling bias, how participants were recruited, who recruited them, and any ethical issues in relation to participant recruitment (Hek, 2000, p 20; PHRU, 2009, online, Bowling, 2002). This author would argue that this is a weakness of the study, as these are crucial elements of quality measurement in primary research within healthcare (Austin, 2001 p 1; Cooper, 2006, p 439; Nuremberg Code, 1949, online). NURS 8700 – DNP Project Mentoring Essay Paper

9. Sample selection

Sample selection is not discussed in any detail, which could be a weakness of the study, as mentioned above (Cormack, 2000). Sample size is stated, but it is not stated whether this was statistically determined, which could also be considered a weakness, as achieving a statistically sound sample size is important within quantitative research (Daggett et al, 2005, p 255; Donovan, 2002).